Healthcare Provider Details

I. General information

NPI: 1710344346
Provider Name (Legal Business Name): JAMES EDELMAN MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OCHSNER1221 S CLEARVIEW PKWY
JEFFERSON LA
70121-1011
US

IV. Provider business mailing address

5750 ABBEY DR
NEW ORLEANS LA
70131-3810
US

V. Phone/Fax

Practice location:
  • Phone: 504-736-4800
  • Fax:
Mailing address:
  • Phone: 201-421-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: